2019 Guidelines for Exercise During Pregnancy

Here’s an (unbelievable) real story. Once upon a time, maybe six years ago, a lovely pregnant mumma sat in my office for a consultation. As always, I asked her about her current activity. She said she’d been told by her doctor to not exercise. Why was this, was she high risk, I asked? Nope. Was she moderate risk? Nope. Any risk? No. Previous miscarriages? Infertility? No and no. Did she have ANY medical conditions at all? No. NOTHING.

Her doctor had simply scoffed when she asked about exercising during her pregnancy. Of course, this patient didn’t quote her doctor’s words exactly to me, but it didn’t matter, the message to this woman, from her doctor, was clear:

you are pregnant and you should not bother with exercise. The end.

The problem is my patient’s experience is not uncommon, even today, years later. I read a comment on social media just the other day from a (pregnant) woman asking if anyone knew if it was recommended that she continue exercising through her pregnancy. And then there are the countless women that I’ve seen who have been told to “slow down!!”, “take it easy!!” and to “cut way back” on their usual exercise during pregnancy. Others have been told or read that they should not start any activity that they don’t currently do (“nothing new!”). So many women who are simply not informed of the benefits of exercise during pregnancy.

Of course, these messages will apply to many women, and each mumma must be provided with safe guidelines to follow, but generally the message that exercise is not important during pregnancy is a load of crap and it’s time that no one doubts that it is.

Thankfully, the 2019 Canadian Guideline for Physical Activity throughout Pregnancy was released in October and it pretty much backs this up. FYI the guidelines had not been updated in fifteen years.

Here is a quote from the introduction of the 2019 guideline:

Unfortunately, uncertainty among some pregnant women and obstetric care providers as to whether prenatal physical activity may increase the risk of miscarriage, growth restriction, preterm birth, fatigue or harm to the fetus have served as barriers to being active. Concerns over harms have not been substantiated by research and the risks of not engaging in prenatal physical activity have not been adequately emphasized. Over the last three decades, the rates of pregnancy complications such as gestational diabetes mellitus, pre-eclampsia, gestational hypertension and newborn macrosomia have risen dramatically, most likely as a consequence of rising rates of maternal obesity.

“The RISKS of NOT engaging in prenatal physical activity have NOT been adequately emphasized.” Hopefully every primary care provider who has not been encouraging their pregnant mummas to move is now.

The guideline indicates that only 15% of pregnant women are meeting the new guideline. Yikes.

The details of the guideline are listed below, but here are the Coles Notes:

  1. YOU MUST EXERCISE DURING PREGNANCY. You must work on strength. You must get your heart rate up.**

** Here is the obligatory note about contraindications (also listed below in more detail). If your doctor or midwife has told you that you cannot exercise for a MEDICAL REASON during your pregnancy, listen to them or seek a second opinion if you question their advice.


Before I copy and paste the new guidelines (below), here are some of the proven benefits of exercise during pregnancy (taken from the guideline).

Women who exercise during pregnancy can expect:

  • a 40% reduction in the chance of developing a major pregnancy complication such as pre-eclampsia, gestational hypertension or gestational diabetes

  • a 25% reduction in the risk of depression

These alone should be enough to get any pregnant mumma up off the couch, but here are a few other benefits that you may experience if you opt to exercise during pregnancy (not discussed in the current guidelines):

  • reduced back ache

  • reduced bloating and/or constipation

  • reduced incontinence (during and after delivery)

  • improved blood flow (swelling, restless leg)

  • improved mood

  • improved sleep

  • improved energy

  • improved muscle tone

  • faster recovery postpartum

  • better weight management

  • easier labour & delivery

  • you’ll feel better about yourself

  • you’ll get lots of smiles

  • you’ll have a smarter, calmer baby in your hands

If that last one isn’t enough!

Swimming during pregnancy is a great way to stay fit and strong.

Swimming during pregnancy is a great way to stay fit and strong.

Six recommendations for exercise during pregnancy:

As outlined by the 2019 Canadian Guideline for Physical Activity throughout Pregnancy.

  1. All women without contraindication should be physically active throughout pregnancy

  2. Pregnant women should accumulate at least 150 minutes of moderate-intensity physical activity each week

  3. Physical activity should be accumulated over a minimum of three days per week

  4. Pregnant women should incorporate a variety of aerobic exercise and resistance training activities to achieve greater benefits

  5. Pelvic floor muscle training (e.g. Kegel exercises) may be performed on a daily basis to reduce the risk of urinary incontinence

  6. Pregnant women who experience light-headedness, experience nausea, or feel unwell when they exercise flat on their back should modify their exercise position to avoid the supine position

Contraindications

All pregnant women can participate in physical activity throughout pregnancy with the exception of those who have contraindications (listed below). Women with absolute contraindications may continue their usual activities of daily living but should not participate in more strenuous activities. Women with relative contraindications should discuss the advantages and disadvantages of moderate-to-vigorous intensity physical activity with their obstetric care provider prior to participation.

The following are absolute contraindications to exercise:

  • Ruptured membranes.

  • Premature labour.

  • Unexplained persistent vaginal bleeding.

  • Placenta praevia after 28 weeks’ gestation.

  • Pre-eclampsia.

  • Incompetent cervix.

  • Intrauterine growth restriction.

  • High-order multiple pregnancy (eg, triplets).

  • Uncontrolled type I diabetes.

  • Uncontrolled hypertension.

  • Uncontrolled thyroid disease.

  • Other serious cardiovascular, respiratory or systemic disorder.

The following are relative contraindications to exercise:

  • Recurrent pregnancy loss.

  • Gestational hypertension.

  • A history of spontaneous preterm birth.

  • Mild/moderate cardiovascular or respiratory disease.

  • Symptomatic anaemia.

  • Malnutrition.

  • Eating disorder.

  • Twin pregnancy after the 28th week.

  • Other significant medical conditions.

You can download the full guidelines here.

Let’s hope that over the next fifteen years the percentage of mummas meeting these guidelines is far greater than the measly 15% who currently do. Let’s go mummas! You got this.